ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDE: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDE (EIN 37-0663567)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-13
IRS object ID
201431339349301503
Schema version
2012v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-05-13T09:19:59-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1191 West Nationwide Blvd Ste 500AddressLine1
CityColumbusCity
StateOHState
ZIP Code432152568ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN370663567EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST ELIZABETH'S HOSPITAL OF THE HOSPITALBusinessNameLine1
Business Name Line2SISTERS OF THE THIRD ORDER OF ST FRANCISBusinessNameLine2
FieldValueIRS element (for citing)
In Care Of Name% JOHNNY WATKINSInCareOfName
Name ControlSTELNameControl
Phone6182342120Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1211 SOUTH THIRD STREETAddressLine1
Address Line2SuiteAddressLine2
CityBELLEVILLECity
StateILState
ZIP Code622201998ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDavid Nosacka DivisionName
TitleCFOTitle
Phone6182342120Phone
Date Signed2014-05-11DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone6142492300Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARYANN REESENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1211 SOUTH THIRD STREETAddressLine1
CityBELLEVILLECity
StateILState
ZIP Code622201998ZIPCode
FieldValueIRS element (for citing)
Gross Receipts166432286GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.STELIZ.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1875YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees1661TotalNbrEmployees
Total Nbr Volunteers244TotalNbrVolunteers
Total Gross UBI26082TotalGrossUBI
Net Unrelated Business Txbl Income2338NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year317879ContributionsGrantsPriorYear
Contributions Grants Current Year443646ContributionsGrantsCurrentYear
Program Service Revenue Prior Year167054450ProgramServiceRevenuePriorYear
Program Service Revenue CY160336773ProgramServiceRevenueCY
Investment Income Prior Year-2523354InvestmentIncomePriorYear
Investment Income Current Year636187InvestmentIncomeCurrentYear
Other Revenue Prior Year2058748OtherRevenuePriorYear
Other Revenue Current Year3432337OtherRevenueCurrentYear
Total Revenue Prior Year166907723TotalRevenuePriorYear
Total Revenue Current Year164848943TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year73654386SalariesEtcPriorYear
Salaries Etc Current Year72356370SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year107971159OtherExpensePriorYear
Other Expenses Current Year107651328OtherExpensesCurrentYear
Total Expenses Prior Year181625545TotalExpensesPriorYear
Total Expenses Current Year180007698TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-14717822RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-15158755RevenuesLessExpensesCY
Total Assets BOY122615352TotalAssetsBOY
Total Assets EOY113735179TotalAssetsEOY
Total Liabilities BOY127642383TotalLiabilitiesBOY
Total Liabilities EOY117771927TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-5027031NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-4036748NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE O.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense42685388Expense
Revenue34541431Revenue
DescriptionCARDIAC SERVICES - SEE SCHEDULE ODescription

Activity2 Activity2

FieldValueIRS element (for citing)
Expense21154968Expense
Revenue20275320Revenue
DescriptionSURGICAL SERVICES - SEE SCHEDULE ODescription

Activity3 Activity3

FieldValueIRS element (for citing)
Expense9681018Expense
Revenue8643105Revenue
DescriptionREHABILITATION SERVICES - SEE SCHEDULE ODescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp74691221TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev96876917TotalOfOtherProgramServiceRev
Total Program Service Expense148212595TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096127NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1661NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJOHNNY WATKINSNamePerson
Telephone Number6182342120TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1211 SOUTH THIRDAddressLine1
CityBELLEVILLECity
StateILState
ZIP Code622201998ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (27 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelatedHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
SISTER JANICE SCHNEIDER OSF
BOARD VICE-CHAIRPERSON1.0XX000
MARYANN REESE
PRESIDENT & CEO60.0XX042800392918
WILLIAM S LYKE
BOARD CHAIRPERSON1.0XX000
THOMAS M EGAN
BOARD SECRETARY1.0XX000
REV JAMES E DEITERS
BOARD MEMBER1.0X000
STEPHANIE STRANO-MAINE
BOARD MEMBER1.0X000
JIM CLANAHAN MD
BOARD MEMBER1.0X000
JACQUELYN M CLEMENT PHD
BOARD MEMEBER1.0X000
SISTER MARYBETH CULNAN OSF
BOARD MEMBER1.0X00059.0
J DAVID MCCAUSLAND
BOARD MEMBER1.0X000
RICHARD J THOMAN
BOARD MEMBER1.0X000
ANWAR KHAN MD
BOARD MEMBER1.0X4000800
ANN M CARR
TREASURER0.25X027214613803159.75
MARK REIFSTECK
DIVISION CEO19.0X04957219844141.0
JOHNNY E WATKINS
DIVISION CFO19.0X27432904586741.0
LESLIE LOVSHIN
CHIEF FINANCIAL OFFICER60.0X156068020152
SHELLEY HARRIS
CHIEF NURSING OFFICER60.0X170108061782
ADAM THACKER
ADMIN DIRECTOR PTCS & PL19.0X1549120285241.0
SHELLY HARKINS MD
CHIEF MEDICAL OFFICER60.0X261341031164
MARGARET LUNA
DIVISION CHIEF PEOPLE OFFICER19.0X12690101486141.0
JAMES BURKE
DIVISION VP OF LEGAL SERVICES19.021585803869341.0X
AMY BALLANCE
VICE PRES BUSINESS DEVELOPMENT19.012947502921241.0X
COREY J HASTINGS
DIVISION CONTROLLER19.012544502887441.0X
SUSAN BEELER
ADMIN DIRECTOR - PATIENT CARE60.0129544026994X
JULIA SCHIMMELPFENNIG
PHARMACY MANAGER60.01266516836X
JAMES RUSHFORD
PHYSICIAN60.033215221446148895X
DONALD JOHNSTON
PHYSICIAN60.032150728419641081X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2564299TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1694527TotalReportableCompFrmRltdOrgs
Total Other Compensation726653TotalOtherCompensation
Number Individuals GT100 K33NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
PROFESSIONAL THERAPY SERVICES INC
2810 FRANK SCOTT PKWY WEST SUITE 8BELLEVILLEIL62223Physical Therapy3192926
SODEXO OPERATIONS LLC
4880 Payshere CircleCHICAGOIL60674Food service1579948
SLU CARE
1402 S Grand BlvdST LOUISMO63104Physician services1241443
AMPHION MEDICAL SOLUTIONS
8301 EXCELSIOR DRIVEMADISONWI53717TRANSCRIPTION SERVIC668457
SOUTHERN IL CARDIOVASCULAR
211 S 3RD STBELLEVILLEIL62220CARDIOVASC SERVICES630000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K34NumberOfContractorsGT100K
Related Organizations177476RelatedOrganizations
Government Grants266170GovernmentGrants
Noncash Contributions0NoncashContributions
Total Contributions443646TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE900000158547047158547047
PHARMACY446110113532113532
HEALTH PROGRAMS90000078477847
ONCOLOGY CENTER INCOME900000887195887195
RENTAL INCOME-AFFILIATED ORGANIZATION900099781152781152
FieldValueIRS element (for citing)
Total Program Service Revenue160336773TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column347948TotalRevenueColumn
Exclusion$347,948ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1372581Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real1289646Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real82935Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column82935TotalRevenueColumn
Exclusion$82,935ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other221887Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other293697Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities360049Securities
Other-71810Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column288239TotalRevenueColumn
Exclusion$288,239ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
ADMINISTRATION INCOME9000002676319$2,676,319
PURCHASE DISCOUNTS900000310167$310,167
CAFETERIA SALES72221069336$69,336

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column293580TotalRevenueColumn
Unrelated Business Revenue26082UnrelatedBusinessRevenue
Exclusion$267,498ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue3349402TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column164848943TotalRevenueColumn
Related Or Exempt Function Income160336773RelatedOrExemptFunctionIncome
Unrelated Business Revenue26082UnrelatedBusinessRevenue
Exclusion$4,042,442ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1283483Total
Program Services674547ProgramServices
Management And General608936ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total51786337Total
Program Services46326327ProgramServices
Management And General5460010ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total5395626Total
Program Services4778576ProgramServices
Management And General617050ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total10112998Total
Program Services8524415ProgramServices
Management And General1588583ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3777926Total
Program Services3345878ProgramServices
Management And General432048ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total2889198Total
Management And General2889198ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total561173Total
Management And General561173ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total33420Total
Program Services33420ProgramServices

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total25590647Total
Program Services22303948ProgramServices
Management And General3286699ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total115725Total
Management And General115725ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1004854Total
Program Services789517ProgramServices
Management And General215337ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total10348903Total
Program Services513452ProgramServices
Management And General9835451ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3716790Total
Program Services3716790ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total138717Total
Program Services81232ProgramServices
Management And General57485ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total40560Total
Program Services35349ProgramServices
Management And General5211ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total857165Total
Management And General857165ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total8864301Total
Program Services7036670ProgramServices
Management And General1827631ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total3202511Total
Program Services469645ProgramServices
Management And General2732866ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES2130434621304346
PROVISION FOR BAD DEBTS1762415017624150
LICENSE AND TAXES71290667128118948
MAINTENANCE & REPAIRS36518683340414311454

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total577934Total
Program Services185801ProgramServices
Management And General392133ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total180007698Total
Program Services148212595ProgramServices
Management And General31795103ManagementAndGeneral
Fundraising0Fundraising
FieldValueIRS element (for citing)
Info In Schedule O Part XXInfoInScheduleOPartX

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY-4023125BOY
EOY2288153EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY7247610BOY
EOY2684512EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY32423111BOY
EOY27297099EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY101817BOY
EOY297060EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2566401BOY
EOY2421397EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1016709BOY
EOY678601EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis205761675LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec145497797LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY62250125BOY
EOY60263878EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY16615232BOY
EOY13255350EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY3944776BOY
EOY4331971EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY472696BOY
EOY217158EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY122615352BOY
EOY113735179EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY15389849BOY
EOY15865587EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY9199BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY62791810BOY
EOY68436234EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY49451525BOY
EOY33470106EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY127642383BOY
EOY117771927EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-11327023BOY
EOY-10926920EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY6226005BOY
EOY6798100EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY73987BOY
EOY92072EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-5027031BOY
EOY-4036748EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY122615352BOY
EOY113735179EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-15158755ReconcilationRevenueExpenses
Reconciliation Unrealized Invest656152ReconciliationUnrealizedInvest
Reconcilation Other Changes15492886ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Org Belongs To Affiliated GroupXOrgBelongsToAffiliatedGroup
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$33,420OtherActivitiesAmount
Total Lobbying Expenditures IIB33420TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF OTHER LOBBYING ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, QUESTION 1IReturnReference
ExplanationST. ELIZABETH'S HOSPITAL ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE ILLINOIS HEALTH ASSOCIATION ("IHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, PART OF WHICH ARE ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Agent Trustee EtcfalseAgentTrusteeEtc
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis3630755OtherCostOrOtherBasis
Book Value3630755BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis118768466OtherCostOrOtherBasis
Depreciation82385041Depreciation
Book Value36383425BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis359390OtherCostOrOtherBasis
Depreciation209365Depreciation
Book Value150025BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis72855752OtherCostOrOtherBasis
Depreciation57395352Depreciation
Book Value15460400BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10147312OtherCostOrOtherBasis
Depreciation5508039Depreciation
Book Value4639273BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings60263878TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
ACCRUED BENEFIT LIABILITY$21,639,040
RETIREMENT OBLIGATION ASBESTOS$8,487,877
SELF INSURANCE COST$3,343,189
FieldValueIRS element (for citing)
Total Of Amounts33470106TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierFIN 48 (ASC 740 FOOTNOTE)Identifier
Return ReferenceSCHEDULE D, PART X, LINE 2ReturnReference
ExplanationHSHS HAS ADOPTED ASC SUBTOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO. 109. ASC SUBTOPIC 740-10 ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER ASC SUBTOPIC 740-10, HSHS MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. ASC SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST, AND PENALTIES ON INCOME TAXES, ACCOUNTING IN INTERIM PERIODS AND REQUIRES INCREASED DISCLOSURES. AT THE DATE OF ADOPTION, AND AS OF JUNE 30, 2013 AND 2012, HSHS DOES NOT HAVE A LIABILITY FOR UNRECOGNIZED TAX BENEFITS.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage600.DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense4398861TotalCommunityBenefitExpense
Net Community Benefit Expense4398861NetCommunityBenefitExpense
Percent Of Total Expense0.02710PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense28199365TotalCommunityBenefitExpense
Direct Offsetting Revenue18468242DirectOffsettingRevenue
Net Community Benefit Expense9731123NetCommunityBenefitExpense
Percent Of Total Expense0.05990PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense32598226TotalCommunityBenefitExpense
Direct Offsetting Revenue18468242DirectOffsettingRevenue
Net Community Benefit Expense14129984NetCommunityBenefitExpense
Percent Of Total Expense0.08700PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs32NumberOfActivitiesOrPrograms
Persons Served8395PersonsServed
Total Community Benefit Expense337219TotalCommunityBenefitExpense
Net Community Benefit Expense337219NetCommunityBenefitExpense
Percent Of Total Expense0.00210PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Persons Served1100PersonsServed
Total Community Benefit Expense2393055TotalCommunityBenefitExpense
Direct Offsetting Revenue584365DirectOffsettingRevenue
Net Community Benefit Expense1808690NetCommunityBenefitExpense
Percent Of Total Expense0.01110PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served4289PersonsServed
Total Community Benefit Expense176908TotalCommunityBenefitExpense
Net Community Benefit Expense176908NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Persons Served3642PersonsServed
Total Community Benefit Expense62740TotalCommunityBenefitExpense
Net Community Benefit Expense62740NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs47NumberOfActivitiesOrPrograms
Persons Served17426PersonsServed
Total Community Benefit Expense2969922TotalCommunityBenefitExpense
Direct Offsetting Revenue584365DirectOffsettingRevenue
Net Community Benefit Expense2385557NetCommunityBenefitExpense
Percent Of Total Expense0.01470PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs47NumberOfActivitiesOrPrograms
Persons Served17426PersonsServed
Total Community Benefit Expense35568148TotalCommunityBenefitExpense
Direct Offsetting Revenue19052607DirectOffsettingRevenue
Net Community Benefit Expense16515541NetCommunityBenefitExpense
Percent Of Total Expense0.10170PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Persons Served875PersonsServed
Total Community Building Expense42567TotalCommunityBuildingExpense
Net Community Building Expense42567NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served320PersonsServed
Total Community Building Expense1726TotalCommunityBuildingExpense
Net Community Building Expense1726NetCommunityBuildingExpense

Other Other

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served350PersonsServed
Total Community Building Expense218TotalCommunityBuildingExpense
Net Community Building Expense218NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs10NumberOfActivitiesOrPrograms
Persons Served1545PersonsServed
Total Community Building Expense44511TotalCommunityBuildingExpense
Net Community Building Expense44511NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$17,624,150BadDebtExpenseAmount
Amount Reimbursed By Medicare50336141AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare48493111CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall1843030MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (4 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnership
MEM & ST ELIZ'S
HEALTHCARE0.50000
HEALTHCARE SVS
SOUTHERN ILLINOIS
FACILITATE CARDIOVASCULAR SVS0.50000
CARDIOVASCULAR FAC
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1St Elizabeth's HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1211 South 3rd StreetAddressLine1
CityBellevilleCity
StateILState
ZIP Code62220ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1St Elizabeth's HospitalBusinessNameLine1
FieldValueIRS element (for citing)
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
OtherXOther
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiesfalseOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs AddressedfalseAllNeedsAddressed
Organization Incur Excise TaxfalseOrganizationIncurExciseTax
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent150.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent600.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Other FactorsXOtherFactors
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
PART I, LINE 3CNot applicable, St. Elizabeth's Hospital follows FPG to determine eligibility for providing charity and discounted care to low-income, uninsured and underinsured individuals.
PART I, LINE 6AThe hospital's community benefit report can be accessed at: http://steliz.org/our-hospital/community-benefit/. Part I, Line 7, Column (F) The percentage of charity care and certain other benefits at cost as a percent of total expenses less bad debt is 10.17%. The amount of bad debt removed when calculating Part I, Line 7, Column (F) was $17,624,150.
PART I, LINE 7The calculation of cost is based on the charges for these services multiplied by the overall cost to charge ratio based on the hospital's financial statements to determine the actual cost of these services.
PART IIUnder Community Building Activities, St. Elizabeth's Hospital provides the following community support: Bridges Connections District 201: This program is designed to help special needs students learn marketable skills through on the job training; up to three students receive two hours of supervised job training. Each student progresses through a three phase program. As they progress through each phase of the program, the Hospital absorbs an increasing percentage of the cost. This program enhances this high risk population's ability to be a productive part of our community. Food, clothing, school supply drives and Elizabeth's Garden: Throughout the year, these programs are supported by hospital colleagues to meet community need. Items are donated to local agencies that work with the poor and/or to local food pantries, in turn reducing the burden of government. In FY2013, colleagues donated 2,100 pounds of clothing, 220 pounds of school supplies and 346 pounds of food to a variety of community social service agencies. Mentoring at Henry Raab Elementary School: The school selects students from low income, at risk families who are in need of an adult role model. Directors/Managers spend one-on-one time with their assigned student to both encourage growth and offer assistance with school work and relationship building. This enhances the learning experience of these children, which will increase their chances of graduating and improve their health outcomes. Disaster Preparedness: St. Elizabeth's Hospital has made a significant investment in emergency management preparedness by initially training 15 colleagues in National Incident Management System and Incident Command System. The hospital participates in numerous emergency management drills in cooperation with our local, region and state partners in addition to our required two annual drills. Pathways Alternative High School: Assisted with an outdoor adventure program for Pathways Alternative High School, a high school for students with significant emotional or behavioral issues. Students scaled a climbing tower to develop confidence and interaction skills with adults and their peers. Under Community Building Activities, St. Elizabeth's Hospital also provides the following for leadership development/training for community members: BASIC Initiative: BASIC (Belleville Achieves Strength in Character) is a partnership of schools, the City of Belleville, and the business community to strengthen character in our youth and in the community. BASIC encourages youth and adults to be productive citizens in our community.
PART III, LINE 4Bad debt expense of HSHS is described on pages 18 and 19 of the audited financial statements, a copy of which is attached to the return.
PART III, LINE 8The hospital continually strives to provide excellent patient care in the most cost effective manner. In FY2013, St. Elizabeth's Hospital had no Medicare shortfall. The amount reported comes from our most recently filed Medicare Cost Report.
PART III, LINE 9BEVERY EFFORT IS MADE PRIOR TO, DURING AND AFTER PROVISION OF MEDICAL SERVICES TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR CHARITY/COMMUNITY CARE AND TO ASSIST THE PATIENT IN COMPLETING THE APPLICATION AND PROVIDING ADEQUATE DOCUMENTATION. IF THE PATIENT QUALIFIED FOR CHARITY/COMMUNITY CARE FOR THE FULL BALANCE OF THEIR ACCOUNT, THE ENTIRE AMOUNT IS WRITTEN OFF TO CHARITY/COMMUNITY CARE AND HENCE NO DEBT COLLECTION IS PURSUED. IF THE PATIENT QUALIFIED FOR CHARITY/COMMUNITY CARE FOR A PORTION OF THEIR ACCOUNT BALANCE, THAT PORTION IS WRITTEN OFF TO CHARITY/COMMUNITY CARE, WITH THE PATIENT BEING RESPONSIBLE FOR THE REMAINDER OF THE BALANCE. ADDITIONALLY, REASONABLE EFFORT WILL BE MADE TO OBTAIN THIRD-PARTY OR GOVERNMENT PAYER REIMBURSEMENT ON BEHALF OF THE PATIENT. IF THOSE EFFORTS ARE NOT FRUITFUL, AN OFFER WILL BE EXTENDED TO THE PATIENT TO MAKE INSTALLMENT PAYMENTS ON THEIR BALANCE. ONLY AT SUCH POINT THAT THE PATIENT DEFAULTS ON INSTALLMENT PAYMENTS OR REFUSES TO COOPERATE WITH THE HOSPITAL'S EFFORTS TO BE REIMBURSED WILL THE ACCOUNT BE SENT TO COLLECTIONS. FOR ADDITIONAL INFORMATION, SEE RESPONSE TO QUESTION VI, 3. Part V, Section B, 1J During Fiscal Year 2012 (July 1, 2011 to June 30, 2012), a Community Health Needs Assessment (CHNA)was conducted by St. Elizabeths Hospital. The hospitals primary service area, considered part of the greater Metropolitan St. Louis Area, includes both urban and rural areas. The 2012 CHNA process identified and the Board of Directors approved the following three strategic initiatives: . Access to healthcare for the underserved and uninsured . Mental health - decrease depression and rate of suicide . Chronic disease - improve management of diabetes
PART V, LINE 3IN MARCH 2012, ST. ELIZABETH'S HOSPITAL HOSTED FIVE TWO-HOUR COMMUNITY ENGAGEMENT SESSIONS WITH 10 TO 15 PARTICIPANTS PER SESSION. PARTICIPANTS WERE INVITED BASED ON THEIR AWARENESS AND EXPERTISE IN THE HEALTHCARE NEEDS OF OUR COMMUNITY. EMPHASIS WAS PLACED ON REPRESENTATION OF THE UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AS WELL AS POPULATIONS WITH CHRONIC DISEASE. NINETY PEOPLE WERE INVITED TO PARTICIPATE. FIFTY-EIGHT PEOPLE ATTENDED ONE OF THE SESSIONS. THE FOLLOWING DESCRIBES THOSE WHO PARTICIPATED AND THE SPECIAL NEED AREAS THEY REPRESENTED ARE SHOWN IN ITALICS: PHYSICIANS (ER, PRIMARY CARE PHYSICIANS, DENTISTS, UROLOGIST) - CHRONIC DISEASE, UNDERSERVED, LOW INCOME, MINORITY PRACTICING NURSES, RETIRED NURSES, HOSPICE NURSES, UNIVERSITY NURSE EDUCATORS, PARISH NURSES - CHRONIC DISEASE BUSINESS LEADERS CIVIC LEADERS (MAYOR'S OFFICE, CHAMBER OF COMMERCE, ALDERMEN) LEGAL COMMUNITY (LAWYER AND JUDGE, ADVISOR FOR THE LEGAL AID SOCIETY) - LOW INCOME, MINORITY HEALTH AGENCIES (AMERICAN CANCER, CALL FOR HELP, FIRST RESPONDERS/EMS) - CHRONIC DISEASE, UNDERSERVED, MINORITY, LOW INCOME COMMUNITY SERVICE AGENCY DIRECTORS - UNDERSERVED, MINORITY, LOW INCOME SCHOOLS REPRESENTATION (PRIMARY AND SECONDARY REPRESENTATION) - UNDERSERVED, MINORITY, LOW INCOME MENTAL HEALTH AGENCY DIRECTORS (INCLUDING ALCOHOL AND DRUG ADDICTION EXPERTS) - UNDERSERVED, MINORITY, LOW INCOME PARENTS OF SPECIAL NEEDS CHILDREN - UNDERSERVED HISPANIC SERVICE AGENCY - UNDERSERVED, MINORITY, LOW INCOME RELIGIOUS LEADERS - INNER CITY AND RURAL - MINORITY, LOW INCOME AGENCY FOR THE AGING - MINORITY MILITARY COMMANDER FOR SCOTT AIR FORCE BASE HEALTH SERVICES COMMUNITY INPUT WAS ALSO OBTAINED THROUGH A HOUSEHOLD SURVEY.
PART V, LINE 4ST. ELIZABETH'S HOSPITAL CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT IN COLLABORATION WITH THE ST. CLAIR COUNTY HEALTH DEPARTMENT, KARLA SMITH FOUNDATION AND 708 MENTAL HEALTH BOARD.
PART V, LINE 5CThe CHNA Report is posted on our Hospital website at: http://steliz.org/our-hospital/community-benefit. In addition, the report is posted on our Hospital Intranet Mission page for our colleagues and was shared with the St. Clair County Health Care Commission at their quarterly meeting in July, 2012.
PART V, LINE 7The St. Elizabeth's Hospital Board of Directors approved the Community Benefit Implementation Strategy based on the FY2012 CHNA. The approved Implementation Strategy was executed in our FY2013. Based on hospital capabilities, resources, severity of the need, and other factors, St. Elizabeth's addressed three areas: . Improve access to healthcare, especially for those who are uninsured or underinsured . Mental health, reduce the rate of depression and suicide in the adult population in the County . Chronic disease, educate and empower diabetics to live a healthier lifestyle The following additional needs were identified and were not addressed directly by the hospital in FY2013 for the reasons indicated. . Mental health - Appropriate services for uninsured: this was partly addressed as a corollary of the Mental Health Suicide/Depression initiative. . Consolidation of community health/resource information: St. Elizabeth's Hospital lacks the expertise to develop and maintain this data base. United Way maintained a data base in their "211" system. . Develop responsibility for one's healthcare: St. Elizabeth's Hospital addresses this issue on a case by case basis (not community level) through our Social Service Department . Geriatric population (access medical/psychiatric): St. Elizabeth's Hospital provides inpatient and outpatient care as part of the Behavioral Healthcare Service line to this population. The hospital lacks adequate space to establish a separate Geriatric-psych program. Addressing the lack of geriatric trained physicians is beyond the scope of this facility. . Violence prevention and safety: This need is an identified need in the IPLAN (Illinois Project for Local Assessment of Needs). The St. Clair County Health Department is the lead agency addressing this need. St. Elizabeth's Hospital lacks the ability to address this issue in any meaningful way. . Lung Cancer and COPD: This need is an identified need in the IPLAN. This issue is being addressed by the hospital, St. Clair County Health Department and other community based programs. . Material and Child Health as related to Infant Mortality, Teen Pregnancy and STD/HIV: This need is an identified need in the IPLAN . The hospital currently has a level 2 NICU with pediatrician on the medical staff, but lacks the required resources to further enhance programs for maternal and child health at this time. PART V, LINE 12h Yes, the Financial Assistance Policy contains a detailed description of the Purpose, Definitions and Guidelines for financial assistance. PART V, LINE 14g Yes, section I of the Financial Assistance Policy describes the "Communication of the Financial Assistance Program to Patients" in detail.
2, NEEDS ASSESSMENTTraditionally, St. Elizabeth's Hospital works closely with the St. Clair County Health Department and participates in developing the County's IPLAN. The IPLAN is a community health assessment and planning process that is conducted every five years by the local health jurisdictions in Illinois. In the past, the IPLAN was used to help determine the hospital's community benefit improvement strategies. In FY2012, a team consisting of a Hospital Administrative Consultant, the Director of Mission Integration and the Director of Pastoral Care facilitated the CHNA for the hospital in collaboration with the St. Clair County Health Department. St. Elizabeth's Hospital's parent organization, Hospital Sisters Health System (HSHS), established a goal for all 13 of its hospitals to complete a CHNA by the end of Fiscal Year 2012. HSHS selected Leede Research, a marketing research firm specializing in health care information, to complete an independent health needs assessment survey of our community. Leede utilized a set of standard health assessment questions and locally defined custom questions. In December 2011, Leede completed 400 telephone surveys in the hospital's primary service area. St. Elizabeth's FY2012 CHNA integrated the following data sources to develop our implementation strategy: . Leede Research Survey . St. Clair County Health Department IPLAN . Missouri Hospital Association - Assessing the Health of Communities . University of Wisconsin County Health Rankings . Dignity Health Community Need Index In March 2012, St. Elizabeth's hosted five two-hour Community Engagement sessions with 10 to 15 participants per session. Participants were invited based on their awareness and expertise in the healthcare needs of our community. Emphasis was placed on representation of underserved, low-income and minority populations as well as populations with chronic disease. Ninety people were invited to participate. Fifty-eight people attended at least one of the sessions. Each session identified the five most significant health needs in our service area, utilizing all of the health data provided, the needs identified in a brainstorming session and the participants' personal expertise to formulate their table's top five health needs. 1. Access to Health Care . Clinics for uninsured . Lack of Primary Care Providers . Insurance costs 2. Education . Healthy living . Healthcare resources . End of Life 3. Mental Health/Addictions 4. Chronic Issues . Diabetes . Cardiac/Pulmonary . Obesity 5. Services . Geriatric . Special needs . Mother/Child The 16 member Community Benefit Steering Committee evaluated the data sources and the Community Engagement Groups results with the hospital's mission and resources. The goal was to determine the needs of our community that could best be addressed by St. Elizabeth's Hospital. This committee represented clinical specialties from the hospital as well as experts from the community, (Director of Community Health, St. Clair County Health Department; Executive Director, St. Clair County 708 Mental Health Board; President Karla Smith Foundation, Suicide and Family Support Group; Pastor, St. Paul's United Church of Christ in Lebanon, IL ). Using four criteria, the Steering Committee members rank ordered the list of health needs identified by the Community Engagement Groups: . Meets the mission of the Hospital . The magnitude of the need . The feasibility or available resources to address those needs . The severity of the health need in our community The Steering Committee identified three primary needs: . Access to healthcare, especially for those who are uninsured or underinsured . Mental health, reduce the rate of depression and suicide in the adult population in the County . Chronic disease, educate and empower diabetics to live a healthier lifestyle Hospital colleagues and community members were assigned to each of the top three health needs. Each committee then focused on one specific priority to define the implementation strategy, taking into account the assets in the community available to help address the health need. Goals, objectives, and indicators were then developed to measure success. St. Elizabeth's Hospital Board of Directors, which includes representation from Religious Leaders, Community Service, Education, Advocacy, Physicians, Expertise in Governance, Business, Organization and Planning, reviewed the FY2013 Community Benefit Implementation Strategy for addressing priorities identified in the most recent CHNA. This report was approved by the Board of Directors Executive Committee on May 25, 2012. The Community Health Needs and associated implementation strategy was used to guide our efforts in FY2013.
3, PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEThe Patient Access Department provides each patient with information about the Christian Assistance Program (CAP) available at St. Elizabeth's Hospital. Patients receive a contact phone number for further assistance. Information about the Christian Assistance Program is also available on the hospital's web site along with the application form and contact numbers. The hospital has a representative on site to assist patients who may be eligible for Medicaid assistance through the Illinois Department of Public Assistance. The hospital representative works with patients and assists them with the application process. Patients determined ineligible for Medicaid are given a CAP Application form and instruction letter with a phone number to contact for further help in making application for assistance. Assistance is provided as needed. Each bill that a patient receives has information about the Christian Assistance Program and a phone number to contact for help in applying. Patients who come to the Cashier's Office are given information about payment options, including the Christian Assistance Program. Even after an account is sent to a collection agency and/or anytime in the process they believe a patient may be eligible for Christian Assistance, the account is returned to the hospital and evaluated for Christian Assistance.
4, COMMUNITY INFORMATIONBelleville, the County Seat for St. Clair County, has a population of 43,756. St. Clair County has a population of 270,259. In St. Clair County, 10% of the population lives in rural communities. The median household income is $49,634 compared to the National income of $53,271. 19.4% of population lives below the poverty line. 27.4% of families earn less than $25,000 a year. Families living below the poverty level was 9.3% compared to National average of 9.2%. In St. Clair County, 8.2% of the population is covered by Medicaid compared to 7.5% for the State. Percent of uninsured adults, non-seniors in the County is 12% compared to 16% for the State of Illinois. The 2013 County Health Rankings rates St. Clair County for Health Factors at 88 out of 102 counties in Illinois (one is best, 102 is worst ranking). (Data from county Health Rankings and US Census data) The primary service area for St. Elizabeth's Hospital covers most of St. Clair County. The secondary service area extends into Monroe, Clinton, Randolph and Madison Counties. Total population of the primary and secondary service area is 353,346 (2010 Census). St. Elizabeth's Hospital also serves as a referral hospital in Hospital Sisters Health System's Southern Illinois Division which includes St. Joseph's Hospital in Highland, St. Joseph's Hospital in Breese and St. Anthony's Memorial Hospital in Effingham. St. Elizabeth's has served this community since its founding in 1875 by the Hospital Sisters of St. Francis. The hospital currently staffs 260 inpatient beds. The hospital employs 1,349 colleagues. Inpatient admissions for Fiscal Year 2013 were 11,361. The Emergency Department had 27,749 visits and admitted 6.322 to inpatient services. The Urgicare Center in O'Fallon, an offsite facility, had 19,440 visits. Total Outpatient visits for the hospital were 161,310. St. Elizabeth's Hospital is a recognized Accredited Chest Pain Center since 2004. The Center received the American Heart Association Mission Life Line Bronze Award for overall Cardiac Care. The Intensive Care Unit for the past five years has been recognized to be in the Top 10% in the nation.
5, PROMOTION OF COMMUNITY HEALTHSt. Elizabeth's Hospital offers hope to our community in the tradition of the Hospital Sisters of St. Francis. As a healing ministry of the Catholic Church and an affiliate of the Hospital Sisters Health System (HSHS), St. Elizabeth's is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded 136 years ago to bring a healing presence and improve the health of our community, especially for people who are sick, poor, and disadvantaged. Because of the hospital's mission and tradition, it is organized to promote the health of St. Clair County and surrounding areas. The hospital is governed by a Board of Directors, the majority of whom reside in the hospital's primary service area and who are neither employees nor contractors of the hospital (nor family members thereof). The Board ensures that St. Elizabeth's Hospital is responding to community need. During the last fiscal year, for example, the Board reviewed the Community Health Needs Assessment and approved an implementation strategy for addressing identified needs. Our Advisory Board and Friends Board consist of persons who reside in our primary service area. Members of these Boards participated in the Community Engagement Groups that were integral in development of the CHNA. Also consistent with its exempt purpose, St. Elizabeth's Hospital has an open medical staff with privileges available to all qualified physicians in the area. In addition, the hospital operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, St. Elizabeth's Hospital reinvests surplus funds into the mission of the organization and health of the community rather than distributing them as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. For example, St. Elizabeth's Hospital is currently working with its parent organization, Hospital Sisters Health System, to continuously enhance quality and improve coordination of care both inside the hospital and with a growing number of physician partners. Supported by investments in information technology, this "care integration" strategy is designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. St. Elizabeth's also devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2013, St. Elizabeth's provided over $16.5 million in community benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, during this period, St. Elizabeth's provided $5.2 million (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance. St. Elizabeth's Hospital provides a range of community benefits that flows from our mission and long-standing commitment to our community. In many cases, these programs would not exist without the leadership role played by St. Elizabeth's Hospital. These programs relieve a burden that would otherwise be carried by government. Several of these programs and activities are designed to respond to our FY2012 Community Health Needs Assessment, which surfaced the following priority needs for attention from the hospital in collaboration with other community organizations: Access to healthcare, especially for those who are uninsured or underinsured: In this new program, St. Elizabeth's is enhancing access to care by working in the new Health Insurance Marketplace (HIM) under the Affordable Care Act. In conjunction with our parent organization Hospital Sisters Health System, the hospital applied for a grant to host at least one In-Person Counselor (IPC), but did not receive. We are planning to provide a community access location within our facility for the HIM staffed by partner organizations with IPC's and Navigators in addition to planned Certified Application Counselors funded by St. Elizabeth's. St. Elizabeth has been active in coordination of efforts around the HIM. Mental health, reduce the rate of depression and suicide in the adult population in the County: In this new program, St. Elizabeth's is partnering with the Karla Smith Foundation (support service for families coping with mental illness and suicide), the local mental health board, Call for Help (provides crisis intervention), local hospice programs under the guidance of the St. Clair County Health Department IPLAN to deploy a depression and suicide risk assessment tool known as QPR (Question, Persuade and Refer). Several members of the partnership have been trained as a Certified QPR Gatekeeper Instructor and are deploying the education in St. Clair County. A St. Elizabeth's Colleague will be trained as a Certified QPR Gatekeeper Instructor in FY14 to increase the pool of certified QPR educators. Chronic disease, educate and empower diabetics to live a healthier lifestyle: For four years St. Elizabeth's has offered outpatient nutrition counseling to help persons with diabetes manage their illness. The 1:1 nutrition counseling session met the individual needs of patients. In 2010 it was identified that there were many people in need of support services who could not afford the cost of the 1:1 counseling sessions. A monthly diabetic education support group was started and the program is offered at no cost. Topics include: carbohydrate counting, stress management, cardiovascular disease, medication management, pain management, exercise and foot care. In January 2012 the Outpatient Dietitian collaborated with the Cardiac Rehab Department and added an exercise component to the Diabetic Support Group. Twice a week the Diabetic Support Group now offers a one hour exercise session in the Cardiac Rehab Gym, followed by a half-hour of yoga. The combination of education and exercise is designed to enhance better outcomes for this patient population. Twenty-one people have joined the exercise group. On average 16 people participate each week in the exercise/yoga session. Ongoing Community Health Programs Breast Health Awareness Month October is Breast Health Awareness month. Annually, St. Elizabeth's Hospital works together to enhance community awareness and connect with civic and community leaders in an effort to educate and raise awareness of the importance of breast health. In FY2013, "Now is the Time" flyers promoting breast health awareness events were available in the hospital, Urgicare Center, and downtown Belleville and O'Fallon; a "Real Men Wear Pink" campaign was launched in the media; and the hospital partnered with the local newspaper and area businesses to promote a "Pink Passion Spa Day," an event hosted at the hospital for women to learn about breast and women's health in a warm and comforting environment. The event included bra fittings, wig and skin care information, mini-manicures, chair massages, women's physical therapy, nutrition information, healthy cooking demo, breast health information and on-site mammogram appointment scheduling. A radiologist, a surgeon, and two OB/GYN physicians were present to answer questions. The Food and Nutrition Department demonstrated healthy cooking ideas and a dietitian was present to answer questions about healthy eating. A healthy Mediterranean themed buffet and drinks were served. More than 70 women participated in the event. As a result of the hospital's Breast Health Awareness month programming, the St. Clair County Health Department reported that 18 women presented to their Breast and Cervical Cancer program for mammograms. Heart2Heart Month February is Heart2Heart Month at St. Elizabeth's Hospital. In FY2013, a mock STEMI drill was held at Sam's Club in O'Fallon to promote awareness of early intervention. The mock drill was comprised of the hospital's cardiac team, the O'Fallon EMS and Sam's Club employees. Shoppers at Sam's Club witnessed a public medical drill that recreated a person having an ST-Elevation Myocardial Infarction (STEMI), also known as a heart attack. This mock chest pain drill helped our hospital and EMS measure response time and practice appropriate medical protocols. St. Elizabeth's colleagues were on hand to share heart health information as part of the mock drill. Mentoring Future Healthcare Professionals St. Elizabeth's Hospital is committed to helping to prepare future healthcare professionals. Students from local Community Colleges and Universities participate in clinical training in the following areas: Nursing, Behavioral Healthcare, Respiratory, Physical & Occupational Therapy, Pharmacy, Radiology, Surgery, Patient
6, AFFILIATED HEALTH CARE SYSTEM.St. Elizabeth's Hospital in Belleville, Illinois is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 13 hospitals, scores of community-based health centers and clinics, and hundreds of physician partners across Illinois and Wisconsin. The Mission of HSHS is "to reveal and embody Christ's healing love for all people through our high quality Franciscan health care ministry." We live our Mission by providing holistic healing to all who seek our care, as well as through Community Benefit. Working collaboratively with others in the communities we serve, our Community Benefit initiatives are strategically and successfully expanding access to care, improving the health status of residents, and furthering medical education and knowledge. In FY2013, our 13 hospitals responded to needs identified in each of their Community Health Needs Assessments (CHNAs) completed in FY2012. The information gathered from these assessments was used to develop new and enhance existing Community Benefit programs and services that best addressed community needs. Included among the many priority needs identified in our CHNAs were chronic disease prevention and management, obesity, adequate food and nutrition, mental health, and access to health care services. HSHS hospitals are proactively addressing these and other needs through patient, provider and community education, preventative screenings, self-management classes, and new or enhanced clinical services. Across HSHS, we collectively provided $185.6 million in Community Benefit (or 10.2% of total hospital expenses) in FY2013. Included in this amount was $45.9 million provided for Financial Assistance (i.e. Charity Care) and $104.2 million for unreimbursed care provided under the Medicaid program. In addition, HSHS hospitals committed significant resources to care for Medicare patients. The cost of providing services to primarily elderly beneficiaries of the Medicare program - in excess of governmental and managed care contract payments - was $152.3 million. HSHS hospitals also recorded $107.1 million in uncollectible accounts. In addition to the dollars invested in our Community Benefit programs, HSHS also continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing do, we ensure we are able to meet the ongoing demand for high quality, efficient and easily accessible health care. Recognizing that the health care delivery model in the United States is evolving, HSHS remains focused on implementing our Care Integration strategy. Care Integration coordinates the delivery of care around the needs of each patient. During FY2013, we made significant progress with this strategy as we further implemented interoperable health information technologies, expanded the number of Medical Homes, and strengthened our alignment with physicians. Greater access to care As a Franciscan health care ministry, HSHS is deeply committed to serving those who are most in need. We not only provide care to every patient who walks through our doors, but also reach out beyond the walls of our hospitals and clinics to care for those in our communities. Our efforts to ensure residents in the communities we serve receive the right care at the right time in the right setting often involve partnering with others to achieve this goal. Across our two-state System, there are numerous examples of HSHS collaborating with other organizations to enhance access to care for those in need. From 2006 to 2009, the United States saw a 16% increase in individuals seeking dental care at hospital emergency rooms. With the support of St. Mary's Hospital Medical Center and St. Vincent Hospital in Green Bay, Wisconsin, the NEW Dental Clinic on the campus of Northeast Wisconsin Technical College expanded in FY2013 and was able to accommodate up to 6,000 visits. The clinic provides dental services to low-income and uninsured persons including the homeless in Brown County. St. Francis Hospital in Litchfield, Illinois partnered with Lewis & Clark Community College to bring their mobile health unit to the Litchfield area; the unit provides dental exams and screenings, x-rays and dental hygiene to those in need. In western Wisconsin, St. Joseph's Hospital in Chippewa Falls works closely with the Chippewa Health Improvement Partnership (CHIP) to support the Open Door Clinic. The free medical clinic provides health care for those without insurance coverage. This past year, the clinic received a total of 2,672 patient visits, an 11% increase from the prior year. With more than 166 individuals volunteering, the clinic provided more than 6,751 hours (including 753 provider hours and 675 nursing hours) of service to individuals. The Open Door Clinic is an example of HSHS providing leadership and support to a community-based program designed to meet the needs of those less fortunate. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between St. Anthony's Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthony's helped underwrite the cost of prescription medications for more than 280 residents. In southwest Illinois, St. Joseph's Hospital in Highland enhanced their offerings to their senior population based on their CHNA. "Senior Renewal" is an outpatient counseling program for senior adults who may be facing emotional and physical problems unique to the aging process such as feelings of loneliness, isolation and anxiety. Clients receive an intensive level of treatment without inpatient hospitalization through counseling strategies and education. In addition, in collaboration with the Illinois Department of Insurance, St. Joseph's Hospital participates in the Senior Health Insurance Program (SHIP), a free health insurance counseling service for Medicare beneficiaries and their caregivers. In addition to programs such as these, HSHS makes sure that those who need financial assistance for care receive it. Our Financial Assistance (i.e. Charity Care) program covers 100% of hospital charges for individuals and families who earn less than 200% of the federal poverty level. HSHS Financial Assistance programs have a sliding scale, in some instances providing up to a 60% discount on charges for those earning up to 600% of the federal poverty level. Counselors are available in our hospitals to explain our financial assistance policies to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Better community health As part of our Mission to embody Christ's healing love, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services. HSHS hospitals also understand we need to listen closely to the residents of the communities we serve to ensure the health care needs of all are being met. To that end, each of our 13 hospitals completed Community Health Needs Assessments (CHNA) during FY2012. The information gathered from these assessments is being used to help us develop new, and enhance existing, programs and services that best address the needs of the community. Among the many priority needs identified from the CHNAs include metabolic and cardiovascular disease management, adequate food and nutrition, and mental health. HSHS hospitals are addressing these and other needs by proactively offering educational opportunities, preventative screenings, and new or enhanced clinical services. In partnership with the Sangamon County Health Department (SCDH) and local farmers, St. John's Hospital in Springfield, Illinois took a lead role in bringing a Farmers Market to the east side of Springfield. The East Side Farmers Market addresses three community needs: childhood obesity, childhood poverty (26% of children in Sangamon County live in poverty vs. 18% in the state) and providing fresh produce to persons living in a known "food desert." WIC Cooking Classes are also offered in tandem with the East Side Farmers Market to teach participants how to prepare fresh produce. The Farmers Market and cooking classes are hosted at the SCDH. St. Mary's Hospital in Streator, Illinois teamed up with the Streator YMCA to offer a 12 week weight loss program - Healthy You - to motivate 282 participants (nearly double the participants from last year) to lose weight and maintain a healthy lifestyle. The program included aerobics classes, cooking classes, and a maintenance program to encourage participants to weigh in monthly. A total of 191 participants comple
STATE FILING OF COMMUNITY BENEFIT REPORTIL,990 SCHEDULE H, PART VI

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARYANN REESE
PRESIDENT & CEO0308148070214049641066859026952052181400
ANN M CARR
TREASURER019345402944004925201211700176860411002018215
MARK REIFSTECK
DIVISION CEO0397173066854031694074658030647060102600
JOHNNY E WATKINS
DIVISION CFO2422370317020390036688010141032115800
LESLIE LOVSHIN
CHIEF FINANCIAL OFFICER12561201723301322303540017312017692000
SHELLEY HARRIS
CHIEF NURSING OFFICER1558870134410780034967027583023265800
ADAM THACKER
ADMIN DIRECTOR PTCS & PL13791200017000028520688015845200
SHELLY HARKINS MD
CHIEF MEDICAL OFFICER2469800014361011295020583029321900
JAMES RUSHFORD
PHYSICIAN31961721355900125359022827801235591703727852236310
DONALD JOHNSTON
PHYSICIAN32108726166000420225362020401260191703543122933660
JAMES BURKE
DIVISION VP OF LEGAL SERVICES21507800780012171027484025551300
AMY BALLANCE
VICE PRES BUSINESS DEVELOPMENT1219060007569040590258200159354000
COREY J HASTINGS
DIVISION CONTROLLER1181010007344042050252910154941000
SUSAN BEELER
ADMIN DIRECTOR - PATIENT CARE129154000390018060096020157206000

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SCHEDULE J, PART I, LINE 1ATax Indemnification and Gross-up PaymentsTax gross-ups were paid by HSHS to Ann Carr for $11 during the year. The fair value of this was included in her annual reported income. SCHEDULE J, PART I, LINE 3 PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15 IN SCHEDULE O. PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15 IN SCHEDULE O.
ANN M. CARRSCHEDULE J, PART I, LINE 4BANN M. CARR PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $42,817.
MARYANN L. REESESCHEDULE J, PART I, LINE 4BMARYANN L. REESE PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $40,277.
MARK REIFSTECKSCHEDULE J, PART I, LINE 4BMARK REIFSTECK PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $48,937.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (15 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990, PART III, LINE 1THE MISSION OF ST. ELIZABETH'S HOSPITAL IS TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. IN THE PERFORMANCE OF ITS MISSION, ST. ELIZABETH'S HOSPITAL WILL FOSTER THE VALUES OF RESPECT, CARE, COMPETENCE AND JOY. RESPECT IS THE FRANCISCAN RESPECT FOR LIFE FROM CONCEPTION TO DEATH AND FOR THE DIGNITY OF EACH INDIVIDUAL PERSON. IT IS A COMMITMENT TO FREEING AND EMPOWERING EACH PERSON TO DEVELOP TO HIS OR HER FULL POTENTIAL. CARE EMBODIES THE CONCERN, COMPASSION, AND SENSITIVITY WITH WHICH WE CARE FOR PATIENTS, CLIENTS, EMPLOYEES AND CO-WORKERS. MANY TIMES IT IS THOUGHT OF AS BEDSIDE BEHAVIOR, BUT IT BELONGS IN BUSINESS OFFICES, CAFETERIAS AND BOARDROOMS. COMPETENCE MEANS THAT OUR WORK IS PERFORMED AND ST. ELIZABETH'S IS MANAGED WITH THE HIGHEST LEVEL OF SKILL AND ABILITY. WE ARE COMMITTED TO RECRUITING AND DEVELOPING PEOPLE WHO ARE COMPETENT IN THEIR WORK AND WHOSE VALUES REFLECT OUR OWN. OUR VALUES ARE AN INTEGRAL PART OF OUR SYSTEM'S STRATEGIC PLAN, WHICH PROVIDES THE OVERALL FRAMEWORK FOR LOCAL ACTIVITIES. JOY IS THE MANNER IN WHICH OUR EMPLOYEES AND ALL WHO JOIN US IN OUR MINISTRY SEEK TO PERFORM THEIR WORK -- THE PERSONAL FULFILLMENT OF CARING FOR OTHERS. IT IS AN ESSENTIAL INGREDIENT IN BRINGING A SENSE OF HOPE TO THOSE WHO SUFFER.
PROGRAM SERVICESFORM 990, PART III, LINE 4ASurgical Services (Expense $42,685,388 Revenue $34,541,431) Our highly trained and experienced surgeons perform surgical and non-surgical procedures in a variety of areas and represent a wide range of specialties, including: cardiothoracic, orthopedic, plastic surgery, neurosurgery, podiatry and more. Your surgical team will perform your surgery using the latest technology and least invasive procedures possible in one of our 16 new surgery suites. Our board certified anesthesiologists and certified nurse anesthetists provide excellent anesthesia care. During FY 2013, St. Elizabeth's Hospital had 4,195 surgical cases. PROGRAM SERVICES FORM 990, PART III, LINE 4B Cardiac Services (Expense $21,154,968 Revenue $20,275,320) St. Elizabeth's provides comprehensive cardiovascular services from diagnosis to surgery to rehabilitation and wellness. St. Elizabeth's is accredited by the Society of Chest Pain Centers, a professional organization focused on improving care for patients with acute coronary syndromes and teaching the public to recognize and react to the early symptoms of a possible heart attack. This accreditation attests that St. Elizabeth's meets strict criteria for recognizing and treating patients who come to the emergency room with heart attack symptoms. We are also a heart attack receiving center. Currently, more than 5 area hospitals send their patients to us for heart attack care. Our patients benefit from our highly credentialed physicians and state-of-the-art technologies, as well as our commitment to superior patient outcomes. Some of the services provided included: Cardiac catheterization, stent placement, stress testing, pacemaker, implantable cardioverter defibrillator (ICD), electrocardiography, coronary artery bypass graft (open heart) surgery and cardiac rehabilitation. During FY 2013, St. Elizabeth's Hospital had 11,801 cardiac cases. PROGRAM SERVICES FORM 990, PART III, LINE 4C Rehabilitation Services (Expense $9,681,018 Revenue $8,643,105) St. Elizabeth's Hospital's comprehensive rehabilitation unit provides the care that maximizes the patient's capabilities. We assist in achieving full recovery potential allowing patients to live as independently as possible. We support patients families by providing them with the education, resources and encouragement needed to achieve positive outcomes. Our comprehensive integrated inpatient rehabilitation program is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). We are one of the few accredited rehab facilities in Southern Illinois and the only one available in St. Clair County. The rehabilitation unit is accredited to provide services to those adults who have been affected by stroke, amputation, arthritis, spinal cord injury, joint replacement, hip fracture, neurological disease, and more. When admitted to our program, patients are treated by a multi-disciplinary team of caring professionals. During FY 2013 our Rehabilitation Unit performed 4,505 cases.
PROGRAM SERVICESFORM 990, PART III, LINE 4DOther Program Services (Expense $74,691,221 Revenue $96,851,792) Health Care Services St. Elizabeth's delivers a comprehensive array of healthcare services to both inpatients and outpatients. Our accredited programs have consistently demonstrated quality outcomes that positively impact our patients, their families and the entire community. We provide quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of St. Elizabeth's Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. It is our mission to serve the sick, especially the poor, with quality healthcare services and healthcare education. We have further defined our mission of identifying those who are at greatest health risk, the elderly, children, those coping with mental illness, and those with less means who are dependent on quality healthcare. St. Elizabeth's Hospital currently staffs 260 inpatient beds. The hospital employs 1,661 colleagues. Inpatient admissions for Fiscal Year 2013 were 11,361. The Emergency Department had 27,749 visits and admitted 6,322 to inpatient services. The Urgi-Center in O'Fallon, an offsite facility, had 19,440 visits. Total Outpatient visits for the hospital were 161,310. Community Benefit Charity and Government Means-Tested Program: During the period, St. Elizabeth's provided in excess of $13,561,291 million to support our commitment to the community. Included in this total was charity care provided to individuals unable to afford their care. The cost of charity care was $3,830,168. St. Elizabeth's Hospital also provided care to persons covered by governmental programs at or below cost. This resulted in providing $9,731,123 to Medicaid patients which was not reimbursed. Also, included in the total was the extensive number of free educational programs, screenings, clinical services and consultations provided at a reduced fee or at no charge to other healthcare agencies and human service agencies in our service area. To the extent that reimbursement was below cost, St. Elizabeth's Hospital recognized these expenses as a cost of fulfilling its mission for the entire community. Other Benefits: St. Elizabeth's Hospital takes a proactive role in educating its communities on wellness programs, sponsoring health screenings, collaborating with the local health district in targeting local health concerns, and organizing support groups. Included in the above Community Benefit figures are initiatives aimed at improving access and promoting health for the people of Belleville and surrounding communities. The total other benefits reported value $2,429,937. In addition to the Community Benefit total, St. Elizabeth's provided 5.1 million (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance.
TAX EXEMPT BONDSFORM 990, PART IV, LINE 24ST. ELIZABETH'S HOSPITAL HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990.
RIGHTS OF MEMBERS TO ELECT GOVERNING BODYFORM 990, PART VI, LINEs 6 & 7ATHE SENIOR GOVERNING BODY OF ST. ELIZABETH'S HOSPITAL (THE CORPORATION) IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS HEALTH SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD AND PRESIDENT.
MEMBER RESERVED POWERSFORM 990, PART VI, LINE 7BRESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. ELIZABETH'S HOSPITAL (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS HEALTH SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBERS OF HSHS ARE THE INDIVIDUAL SISTERS WHO FROM TIME TO TIME ARE THE DULY ELECTED PROVINCIAL SUPERIOR AND PROVINCIAL COUNCILORS, RESPECTIVELY OF THE AMERICAN PROVINCE OF THE HOSPITAL SISTERS OF ST. FRANCIS ("AMERICAN PROVINCE"). THE AMERICAN PROVINCE IS THE UNITED STATES ORGANIZATION OF THE CONGREGATION OF THE HOSPITAL SISTERS OF THE THIRD ORDER REGULAR OF ST. FRANCIS, A RELIGIOUS INSTITUTE OF THE ROMAN CATHOLIC CHURCH. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMEND ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, OR THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHANGE, LEASE OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILIATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (H) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (I) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE (II) CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (K) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (L) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (M) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; AND (N) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI.
FORM 990 REVIEW PROCESSFORM 990, PART VI, LINE 11bTHE HOSPITAL EMPLOYS KPMG TO ASSIST IN THE OVERALL PREPARATION, REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. KPMG PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, LINE 12CA REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAS BEEN USED SINCE JANUARY, 2009 TO ESTABLISH THE PRACTICE OF MANAGING CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH OUR CONFLICT OF INTEREST POLICY ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP OR ACTIVITY CONTEMPLATED, ENTERED INTO OR CONDUCTED AT HSHS. THE POLICY DEFINES COVERED PERSONS AS A.) BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST AND B.) NON-EMPLOYED MEMBERS OF THE MEDICAL STAFF WHO ALSO EITHER: 1) HOLD PAID OR UNPAID MEDICAL ADMINISTRATIVE POSITIONS, SUCH AS CHAIRS OF CLINICAL DEPARTMENTS, SECTION AND DIVISION CHIEFS, DIRECTORS OF SPECIAL CARE UNITS, DIRECTORS OF RESEARCH OR INDIVIDUALS WHO OTHERWISE DIRECT OR MATERIALLY INFLUENCE RESEARCH; OR 2) HAVE PROCUREMENT RESPONSIBILITY, OR THE AUTHORITY EFFECTIVELY TO RECOMMEND SUCH PROCUREMENT. ON AN ANNUAL BASIS HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS AND TOOLS), TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. THE COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT, SYSTEM RESPONSIBILITY, VICE PRESIDENT, RISK & COMPLIANCE OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON SHALL PROMPTLY DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE OF HSHS WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, HSHS SHALL NOT ENGAGE IN OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS;AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH THE COVERED PERSON OR PERSONS WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP ARRANGEMENT OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES.
WHISTLEBLOWER POLICYFORM 990, PART VI, LINE 13PROVISIONS WITHIN THE CORPORATE COMPLIANCE HOTLINE AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES.
COMPENSATION PROCESSFORM 990, PART VI, LINE 15THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL DISQUALIFIED INDIVIDUALS. INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES AND BENEFITS FOR THE DISQUALIFIED INDIVIDUALS. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION FOR THE DISQUALIFIED INDIVIDUALS. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING. JOINT VENTURES FORM 990 PART VI, LINE 16B HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS, INCLUDING ST. ELIZABETH'S HOSPITAL. THE OVERALL PURPOSE OF THE POLICY IS TO PROVIDE PRACTICAL GUIDELINES FOR ETHICAL BUSINESS CONDUCT, TO ACHIEVE COMPLIANCE, AND TO DETECT AND PREVENT VIOLATIONS OF APPLICABLE LAWS. THE POLICY REQUIRES ST. ELIZABETH'S HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD ST. ELIZABETH'S HOSPITAL'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS.
DISCLOSURE: DOCUMENTS AVAILABLE TO THE PUBLICFORM 990, PART VI, LINE 19BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME.
POOLED INVESTMENT ACCOUNTFORM 990, PART X, LINE 11PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF SFAS NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE VALUES AND ALL INVESTMENTS IN DEBT SECURITIES ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE PARTICIPANTS.
OTHER CHANGES IN NET ASSETS OR FUND BALANCESFORM 990, PART XI, LINE 5SWAP PAYMENTS (517,635) CHANGES IN PENSION 16,927,520 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 5,673,358 AFFILIATE TRANSFER (4,548,500) BOND REALLOCATION (1,833,743) INCREASE IN TEMPORARILY RESTRICTED ASSETS 143,727 PERMANENTLY RESTRICTED NET INCOME 18,086 Loss on Extinguishment of Debt (369,927) ------------- TOTAL OTHER CHANGES IN NET ASSETS OR FUND BALANCES 15,492,886 =============
OTHER FEES FOR SERVICES FOR NON-EMPLOYEESFORM 990 PART IX LINE 11GDESCRIPTION:PURCHASED SERVICES TOTAL FEES:21155819
OTHER FEES FOR SERVICES FOR NON-EMPLOYEESFORM 990 PART IX LINE 11GDESCRIPTION:PROFESSIONAL SERVICES TOTAL FEES:4434828

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
SPRINGFIELD HEALTH PARTNERS LLC
4936 LAVERNA ROADSPRINGFIELDIL62707371364419HEALTHCAREIL0HSHS MG
KIARA CLINICAL INTEGRATION NETWORK LLC
4936 LAVERNA RDSPRINGFIELDIL62707261417684HEALTHCAREIL0KIARA INC
PHYSICIAN CLINICAL INTEGRATION NETWORK
4936 LAVERNA ROADSPRINGFIELDIL62707371668647HEALTHCAREIL0KCIN

Form990 Schedule R Part II Form990ScheduleRPartII (23 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
HOSPITAL SISTERS HEALTH SYSTEM
4936 LAVERNA ROADSPRINGFIELDIL62707371058692HEALTHCAREIL501(C)(3)11ANAfalse
HOSPITAL SISTERS SERVICES INC
4936 LAVERNA ROADSPRINGFIELDIL62707371163402HEALTHCAREIL501(C)(3)11AHSHSfalse
HOSPITAL SISTERS OF ST FRANCIS FDTN
4936 LAVERNA ROADSPRINGFIELDIL62707371186514HEALTHCAREIL501(C)(3)11AHSHSfalse
HSHS SELF INSURANCE TRUST FUND
4936 LAVERNA ROADSPRINGFIELDIL62707371120626INSURANCEIL501(C)(3)11AHSHSfalse
HSHS HEALTH CARE PLAN TRUST FUND
4936 LAVERNA ROADSPRINGFIELDIL62707371137724HEALTHCAREIL501(C)(9)N/AHSHSfalse
HOSPITAL SISTERS HEALTHCARE - WEST INC
2661 COUNTY HIGHWAY ICHIPPEWA FALLSWI54729510157933HEALTHCAREWI501(C)(3)11AHSSIfalse
SACRED HEART HOSPITAL
900 WEST CLAIREMONT AVENUEEAU CLAIREWI54701390807060HEALTHCAREWI501(C)(3)3HSSIfalse
ST ANTHONY'S HOSPITAL
503 N MAPLE STREETEFFINGHAMIL62401370661233HEALTHCAREIL501(C)(3)3HSSIfalse
ST JOHN'S HOSPITAL
800 EAST CARPENTER STREETSPRINGFIELDIL62769370661238HEALTHCAREIL501(C)(3)3HSSIfalse
ST FRANCIS HOSPITAL
1215 FRANCISCAN DRIVELITCHFIELDIL62056370661236HEALTHCAREIL501(C)(3)3HSSIfalse
ST JOSEPH'S HOSPITAL
9515 HOLY CROSS LANEBREESEIL62230371208459HEALTHCAREIL501(C)(3)3HSSIfalse
ST JOSEPH'S HOSPITAL
1515 MAIN STREETHIGHLANDIL62249370663568HEALTHCAREIL501(C)(3)3HSSIfalse
ST JOSEPH'S HOSPITAL
2661 COUNTY HIGHWAY 1CHIPPEWA FALLSWI54729390810545HEALTHCAREWI501(C)(3)3HSSIfalse
ST MARY'S HOSPITAL
1800 E LAKE SHORE DRIVEDECATURIL62521362169181HEALTHCAREIL501(C)(3)3HSSIfalse
ST MARY'S HOSPITAL
111 SPRING STREETSTREATORIL61364362169181HEALTHCAREIL501(C)(3)3HSSIfalse
ST NICHOLAS HOSPITAL
3100 SUPERIOR AVENUESHEBOYGANWI53081390808480HEALTHCAREWI501(C)(3)3HSSIfalse
ST VINCENT HOSPITAL
835 S VAN BURENGREEN BAYWI54301390817529HEALTHCAREWI501(C)(3)3HSSIfalse
ST MARY'S HOSPITAL MEDICAL CENTER
1726 SHAWANO AVENUEGREEN BAYWI54303390818682HEALTHCAREWI501(C)(3)3HSSIfalse
HSHS MEDICAL GROUP INC
3215 EXECUTIVE PARK DRIVESPRINGFIELDIL62703263956318HEALTHCAREIL501(C)(3)11AHSSIfalse
HSHS WISCONSIN MEDICAL GROUP INC
3215 EXECUTIVE PARK DRIVESPRINGFIELDIL62703264515959HEALTHCAREWI501(C)(3)11AHSSIfalse
ORANGE CROSS AMBULANCE INC
919 ASHLAND AVESHEBOYGANWI53081391860942HEALTHCAREWI501(C)(3)9ST NICHOLASfalse
WISCONSIN UPPER PEN ONC MNGMT SERVICES
835 S VAN BURENGREEN BAYWI54304391677100HEALTHCAREWI501(C)(3)3ST VINCENTfalse
UNITY LIMITED PARTNERHSHIP
2366 OAK RIDGE CIRCLEDE PEREWI54115391750729HEALTHCAREWI501(C)(3)9HSSIfalse

Form990 Schedule R Part III Form990ScheduleRPartIII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsCode VCodeVAmountGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
MEMORIAL AND ST ELIZABETH'S HEALTHCARE
4000 NORTH ILLINOIS STREETSWANSEAIL62226371312961HEALTHCAREILNARELATED14160924344686false$0false0.50000
PRAIRIE HEART INSTITUTE - CARBONDALE LL
800 EAST CARPENTER STREETSPRINGFIELDIL62769371321197HEALTHCAREILST JOHN'SRELATEDfalse$0
NORTHEAST WISCONSIN RADIATION THERAPY SE
1821 S WEBSTER AVENUE SUITE 300GREEN BAYWI543079047263749065HEALTHCAREWIHSSIRELATEDfalse$0
PAIN CENTER OF WISCONSIN
4131 W LOOMIS ROAD SUITE 300GREENFIELDWI53221263155343HEALTHCAREWIST VINCENTRELATEDfalse$0
SURGERY CENTER OF SHEBOYGAN LLC
3141 SAEMANN AVESHEBOYGANWI53081260822209HEALTHCAREWIST NICHOLASRELATEDfalse$0
PREVEA VENTURES LLC
2710 EXECUTIVE DRGREEN BAYWI54304203775127HEALTHCAREWIHSSIRELATEDfalse$0
CARPENTER STREET HOTEL LLC 36-
HOTELILLASANTE INCRELATEDfalse$0
SPRINGFIELD URGENT CARE REAL E
ILLASANTE INCRELATEDfalse$0
PRAIRIE HEART INSTITUTE MANAGEMENT LLC
4936 Laverna RoadSpringfieldIL62707261417684MedicalILHSHSRelated00falsefalse

Form990 Schedule R Part IV Form990ScheduleRPartIV (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityControlled OrgControlledOrgAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountryShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssets
KIARA INC
4936 LAVERNA RDSPRINGFIELDIL62707371163401HEALTHCAREILHSHSC CORPfalse
LASANTE WISCONSIN INC
4936 LAVERNA RDSPRINGFIELDIL62707391572196HEALTHCAREILKIARA INCC CORPfalse
LASANTE INC
4936 LAVERNA RDSPRINGFIELDIL62707371163400HEALTHCAREILKIARA INCC CORPfalse
PRAIRIE CARDIOVASCULAR
619 EAST MASON SUITE 4P57SPRINGFIELDIL62701371071858HEALTHCAREILKIARA INCC CORPfalse
PREVEA HEALTH SERVICES
2710 EXECUTIVE DRGREEN BAYWI54304391839351HEALTHCAREWIHSSIC CORPfalse
PREVEA CLINIC INC
2710 EXECUTIVE DRGREEN BAYWI54304391839349HEALTHCAREWIHSSIC CORPfalse
PREVEA HEALTH NETWORK
2710 EXECUTIVE DRGREEN BAYWI54304392000537HEALTHCAREWIHSSIC CORPfalse
RENAISSANCE QUALITY INSURANCE
980669953INSURANCEHSSIC CORPfalsePO Box 1159 KY1-1102GRAND CAYMANCAYMAN ISLANDSCJKY1-1102CJ00
OJV INC
4936 LAVERNA RDSPRINGFIELDIL62707460873384HEALTHCAREILLASANTEC CORPfalse00
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierTRANSACTIONS WITH RELATED ENTITIESIdentifier
Return ReferenceFORM 990 SCHEDULE R, PART V, LINE 2ReturnReference
ExplanationTHE TRANSACTIONS REPORTED IN QUESTION 1 ARE BETWEEN RELATED 501(C)(3) PUBLIC CHARITIES AND ARE NOT REPORTED IN THIS SECTION.Explanation

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